Long Term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals with Type 2 Diabetes: Four Year Results of the Look AHEAD Trial

By R. Wing. Archives of Internal Medicine, 2010

1,268 citations recorded by the source corpus.

Objective Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes, but no long-term data are available. We examined the effects of a lifestyle intervention on changes in weight, fitness and cardiovascular (CVD) risk factors over 4 years. Research Design and Methods Look AHEAD is a multi-center randomized clinical trial comparing the effects of intensive lifestyle intervention (ILI) and diabetes support and education (DSE, control group) on the incidence of major CVD events in 5145 individuals with type diabetes, aged 45 to 76 years, who were overweight or obese (BMI > 25 kg/m2). Participants have ongoing intervention and annual assessments. Results Averaged across four years of follow-up, participants in ILI had greater percent weight losses than those in DSE (−6.15% vs −0.88%, p<.0001) and greater improvements in fitness (12.74% vs. 1.96%, p < .0001), HbA1c (A1c, −0.36% vs. 0.09%, p<.0001), systolic blood pressure (SBP, −5.33 vs. −2.97 mmHg, p<.0001), diastolic blood pressure (DBP, −2.92 vs. −2.48 mmHg, p<.012), HDL-cholesterol (HDL-C, 3.67 vs. 1.97 mg/dl, p<.0001), and triglycerides (−25.56 vs. −19.75 mg/dl, p<.0006). Reductions in LDL-C were greater in DSE than ILI (−11.27 vs. −12.84 mg/dl, p=.009), but adjusted for medication use, changes in LDL-C did not differ between the two groups. Although the greatest benefits were often seen at 1 year, ILI participants still had greater improvements than DSE in weight, fitness, HbA1c, SBP, and HDL-C at 4 years. Conclusions Intensive lifestyle intervention can produce and maintain significant weight losses and improvements in fitness in individuals with type 2 diabetes. Across four years of follow-up, those in ILI had better overall levels of glycemic control, blood pressure, HDL-C and triglycerides, and thus spent considerable time with lower CVD risk. Whether this translates to reduction in CVD events will ultimately be addressed by the Look AHEAD study.

Subfields: Endocrinology, Diabetes and Metabolism

View Paper: https://www.semanticscholar.org/paper/d3eeee300bd6776ebba55336aadbb944becf2aa3

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In Endocrinology, Diabetes and Metabolism

1. F. B. Hu
2. V. Basevi
3. A. Chait
4. C. Apovian
5. Laura J. den Hartigh
6. T. Wadden
7. S. Grundy
8. Gerald I. Shulman

Citations in the corpus

• 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults (2013, methodology): “The remain ing 28 publications were rated good or fair quality and included in the evidence base that was used to form ulate the ESs and recommendations (12-39).”
• Adipose Tissue Distribution, Inflammation and Its Metabolic Consequences, Including Diabetes and Cardiovascular Disease (2020, result): “As the subjects recruited for the Look AHEAD trial had T2DM, this and other post-hoc analyses suggest that weight loss in T2DM subjects also lowers the risk of CVD events (499, 500).”
• Standards of Medical Care in Diabetes—2012 (2011, background): “6% weight loss, significant reduction of A1C, and reduction in several CVD risk factors (124), with benefits sustained at 4 years (125).”
• Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019, methodology): “More recently, the Look AHEAD trial (139,141) compared standard DSMES to a more intensive lifestyle intervention and reduced-calorie eating plan.”
• Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations (2020, background): “time of diagnosis.(196) There is growing evidence to support intentional weight loss post-treatment in cancer survivors, which may result in improved prognosis and OS.”
• Standards of Medical Care in Diabetes—2013 (2012, background): “6% weight loss, significant reduction of A1C, and reduction in several CVD risk factors (138), with benefits sustained at 4 years (139).”
• Exercise standards for testing and training: a scientific statement from the American Heart Association. (2013, background): “Ongoing aerobic exercise, in association with a behavioral weight loss program, has been demonstrated to significantly decrease the clinical progression from insulin resistance to type 2 diabetes mellitus(448) and yields improved diabetic control for individuals with established type 2 diabetes mell”
• Treatment of NAFLD with diet, physical activity and exercise. (2017, background): “840 haemoglobin A1c levels remained below preintervention levels, and the reduction remained clinically meaningful.(162) Nevertheless, in the study by Vilar-Gomez et al.”